Karina Wahl

Quetiapine addition to serotonin reuptake inhibitors in patients with severe obsessive-compulsive disorder: a double-blind, randomized, placebo-controlled study.

Objective: Although many patients with obsessive-compulsive disorder (OCD) benefit from treatment with serotonin reuptake inhibitors (SRIs), it is estimated that 40% to 60% of them do not respond. The objective of the present study was to evaluate the efficacy of quetiapine added to baseline treatment with SRIs for the treatment of OCD in severely ill adult subjects. Method: Forty patients (21 men, 19 women) with primary OCD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria participated in a 12-week, double-blind, placebo-controlled trial. They were randomly assigned to dosages of quetiapine titrated up to 400 mg/d (n = 20) or to placebo (n = 20) in addition to their SRI treatment. During the continuation phase (weeks 6-12), subjects received different dosages between 400 and 600 mg/d depending on clinical response. At entry, all patients were unresponsive to at least 1 course of at least 12 weeks of treatment with SRIs at defined doses. The total Yale-Brown Obsessive-Compulsive Scale score was the primary efficacy parameter. Results: Intention-to-treat, last-observation-carried-forward analysis demonstrated a mean ± SD decrease in Yale-Brown Obsessive-Compulsive Scale score of 5.2 ± 5.4 in the quetiapine group and 3.9 ± 4.9 in the placebo group. The analysis of treatment effects between the 2 groups showed no significant difference. There were no significant group differences in any of the other self-rating scales or clinician-administered rating scales. Conclusions: In this study, augmentation of SRI treatment with quetiapine in severe OCD had no additional effect.

Neither Saints nor Wolves in Disguise Ambivalent Interpersonal Attitudes and Behaviors in Obsessive-Compulsive Disorder

Inflated responsibility is ascribed a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). The aim of the study was to assess interpersonal attitudes and behaviors contributing to enhanced responsibility in OCD. In particular, we tested the hypothesis that individuals diagnosed with OCD share stronger latent aggression toward others, resulting in a high degree of interpersonal ambivalence. A total of 176 participants with OCD, 42 participants with anxiety or depression as well as 42 healthy controls completed the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). The factor analysis confirmed three factors: (1) inflated worry/responsibility, (2) latent aggression/calculating behavior and (3) suspiciousness/distrust. Whereas the psychiatric group displayed enhanced scores relative to healthy participants regarding responsibility and suspiciousness, OCD patients achieved significantly higher scores on the latent aggression dimension relative to both control groups. Results are consistent with the notion that participants with OCD show both inflated levels of (authentic) responsibility and latent aggression.

Relations between a ruminative thinking style and obsessive-compulsive symptoms in non-clinical samples

Abstract There is tremendous interest in understanding the cognitive processes behind obsessive–compulsive disorder (OCD). Whereas previous research on cognitive OCD models has focused on the dysfunctional content of obsessional thinking, processes and styles of thinking have not yet been investigated. The present study investigated the relationship between a ruminative response style and obsessive–compulsive (OC) symptomatology in two non-clinical samples. In Sample 1, 261 students completed the Ruminative Response Scale, the Padua-Inventory, Revised, and the Beck Depression Inventory. Tendency to ruminate was positively correlated with the severity of OC symptoms and particularly with obsessive rumination, even after controlling for depression. Results were replicated in Sample 2 (211 students). Data indicate that a ruminative response style and obsessive rumination share common processual features. Understanding the interaction between rumination and obsessional thinking might help to further elucidate the role of cognitive vulnerability factors in OCD and to expand cognitive and metacognitive models of OCD.

Dimensionen zwangsspezifischer Einstellungen

Zusammenfassung. Theoretischer Hintergrund: Dysfunktionale Einstellungen und daraus resultierende Fehlinterpretationen auftretender Intrusionen stellen den Kern des kognitiv-behavioralen Modells der Zwangsstorung dar. Fragestellung: Struktur und psychometrische Eigenschaften der deutschen Version des „Obsessive-Beliefs Questionnaire” (OBQ) zur Erfassung zwangstypischer kognitiver Verzerrungen wurden untersucht. Methode: Konfirmatorische und explorative Faktorenanalysen an einer nicht-klinischen (n = 247) sowie einer Patientenstichprobe (n = 188) kamen zum Einsatz. Interne Konsistenz, Retest-Reliabilitat, konvergente und diskriminante sowie Kriteriumsvaliditat wurden ermittelt. Ergebnisse: Die Originalstruktur konnte nicht repliziert werden und eine Itemreduktion wurde vorgenommen. Die gekurzten Skalen weisen zufrieden stellende Kennwerte fur Reliabilitat sowie Validitat auf. Schlussfolgerungen: Die Analysen legen die Verwendung einer gekurzten Version des OBQ fur den deutschen Sprachraum nahe.

A new understanding of attention-deficit disorders--beyond the age-at-onset criterion of DSM-IV.

For decades, ADHD has been seen primarily as a behavior disorder affecting only young children, primarily boys, causing them to be inattentive and disruptive in school. Research has now established that ADHD affects females as well as males, and that impairing symptoms, for most, persist into adulthood. It has also been shown that this disorder impacts many aspects of life that extend well beyond problems in school. This disorder impairs not only one’s ability to sit still and listen, but also the capacity to organize tasks and materials, to sustain effort on tasks, and to utilize short-term memory for daily activities.Studies of children, adolescents, and adults with ADHD indicate that many suffer from a variety of cognitive impairments that extend beyond symptoms listed in the DSM-IV diagnostic criteria for ADHD. These include chronic problems in regulating alertness, in reading comprehension, and in modulating emotions, that occur more frequently in persons with ADHD than in the general population. This article describes recent research findings demonstrating the wide range of cognitive impairments associated with ADHD, which are related to a new model of ADHD, such as developmental impairment of executive functions of the brain.

Sagen dysfunktionale Kognitionen den Therapieerfolg voraus

Zusammenfassung. Theoretischer Hintergrund: Dysfunktionale Kognitionen stellen den Kern des kognitiv-behavioralen Modells zur Erklarung psychischer Storungen dar. Fragestellung: In einer Langsschnittstudie wird gepruft, ob die Reduktion von Angst- und depressiver Symptomatik mit dem Ausmas und der Reduktion dysfunktionaler Kognitionen zusammenhangt. Methode: N = 87 Patienten mit den Diagnosen Zwangsstorung, Major Depression und Panikstorung bzw. Agoraphobie beantworteten vor und nach einer kognitiven Verhaltenstherapie Fragebogen zu Symptomatik, dysfunktionalen Einstellungen, Sorgen und Grubeln. Ergebnisse: Die Patienten verbessern sich im Therapieverlauf hinsichtlich kognitiver Inhalte und Prozesse sowie der Belastung. Ausgepragte Sorgen zu Therapiebeginn korrelieren mit weniger Besserung angstlicher Symptomatik, Reflektion ist dagegen ein protektiver Faktor. Die Abnahme dysfunktionaler Einstellungen sagt die Reduktion der Angstlichkeit, die Abnahme des Sorgens die Reduktion der Depressivitat vorher. Sch...

Die Kognitive Verhaltenstherapie der Zwangsstörungen State of the Art

Zusammenfassung: Die zentralen psychotherapeutischen Interventionen der kognitiven Verhaltenstherapie umfassen eine ausfuhrliche Diagnostik und Bedingungsanalyse, die Entwicklung eines Entstehungs- und Aufrechterhaltungsmodells und - nach einer umfassenden kognitiven Vorbereitungsphase - schlieslich eine intensive Ubungsphase mit Expositionsubungen und Verhaltensexperimenten. Kognitive und verhaltenstherapeutische Elemente sind eng miteinander verwoben. Dysfunktionale, automatisch auftretende Fehlinterpretationen der Zwangsgedanken sowie langfristig bestehende hinderliche Grundannahmen werden sowohl durch Methoden der kognitiven Umstrukturierung auf der Gesprachsebene als auch durch gezielte Verhaltensexperimente und Expositionsubungen hinterfragt. Die klassische Exposition mit Habituationsrational wird somit erganzt und eingebettet in eine systematische Hinterfragung hinderlicher Einstellungen. Ein besonderer Schwerpunkt liegt im weiteren Verlauf der Therapie auf dem Ubergang ins Selbstmanagement mit dem...